Prevention and Treatment of Postpartum Hypertension
There is not enough evidence to guide management of women who are hypertensive postpartum or at increased risk of becoming so. Level of evidence: "D"A Cochrane review [Abstract] 1 included 9 studies with a total of 668 subjects.
Prevention
- Four trials (358 women) compared furosemide, nifedipine capsules, or L-arginine with placebo/no therapy. For women with antenatal pre-eclampsia, postnatal furosemide compared with placebo/no therapy was associated with a strong trend towards reduced use of antihypertensive therapy in hospital (RR 0.74, 95% CI 0.55 to 1.00; 1 study, n= 264). The direction of effect was the same for antihypertensive therapy at hospital discharge but the results were not statistically significant (RR 0.81, 95% CI 0.59 to 1.12; 2 studies, n = 282).
Treatment
- In three trials (189 women), oral timolol, hydralazine, or nifedipine were compared with methyldopa for treatment of mild to moderate postpartum hypertension. Use of additional antihypertensive therapy did not differ between groups (RR 0.92, 95% CI 0.20 to 4.20), but the trials were not consistent in their effects. The drugs were well tolerated. In two trials (120 women), intravenous hydralazine was compared with either sublingual nifedipine or intravenous labetalol for treatment of severe postpartum hypertension. There were no maternal deaths or hypotension. Use of additional antihypertensive therapy did not differ between groups (RR 0.58, 95% CI 0.04 to 9.07), but the trials were not consistent in their effects.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and lack of blinding), by inconsistency (variability in results across studies), and by imprecise results (limited study size for each comparion).
References
- Magee L, von Dadelszen P. Prevention and treatment of postpartum hypertension. Cochrane Database Syst Rev 2013;(4):CD004351. [PubMed].